Active NPI
Kay A Wanner, LRD, CDE
- Nutritionist
- Bismarck, ND
National Provider Identifier
1689619397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- 413
- Practice address
- 401 N 9TH St
Bismarck, ND 58501-4507 - Phone
- (701) 530-6000
- Fax
- (701) 530-6430
- NPI assigned
- Jun 17, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | 413 | ND | Primary |
Addresses
Primary practice location
401 N 9TH St
Bismarck, ND 58501-4507
Mailing address
401 N 9TH St
Bismarck, ND 58501-4507
Phone (701) 530-6000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 52623 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 413 | ND | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192579200000",
"number": "1689619397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 N 9TH ST",
"city": "BISMARCK",
"state": "ND",
"postal_code": "585014507",
"telephone_number": "701-530-6000",
"fax_number": "701-530-6430"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 N 9TH ST",
"city": "BISMARCK",
"state": "ND",
"postal_code": "585014507",
"telephone_number": "701-530-6000",
"fax_number": "701-530-6430"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANNER",
"first_name": "KAY",
"middle_name": "A",
"credential": "LRD, CDE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-17",
"last_updated": "2007-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "ND",
"license": "413",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "52623",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bismarck, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.